Clinical Features and Visual Outcomes of Pediatric Noninfectious Posterior and Panuveitis

Purpose To describe the demographics, clinical characteristics, treatment patterns, and outcomes of pediatric patients with noninfectious posterior and panuveitis at a single center.Methods Retrospective cohort study of all eyes with posterior and panuveitis between June 2015 and June 2025 that were identified using ICD codes. Charts were reviewed for demographics, clinical characteristics, disease evolution, sequelae, and treatment. Eyes with less than 3 months of follow-up were excluded.Results Between 2015 and 2025, a total of 12 004 patients (16,810 eyes) were seen for any uveitis diagnosis. Of them, 281 children (449 eyes) were referred for a diagnosis of non-infectious uveitis and 106 eyes of 69 patients met inclusion criteria. Bilateral disease occurred in 50.7% of patients. The leading diagnosis was idiopathic uveitis (51.9% of eyes), with a mean follow-up of 42 months. Nearly all eyes experienced at least one inflammatory flare (mean 1.1 per eye). Topical corticosteroids were most used (60.9% of treated eyes). Ocular sequelae were nearly universal (98.1%), and the proportion of patients with vision 20/200 or worse remained stable from baseline to follow-up (39.1% vs 40.6%). Linear mixed-effects modeling identified glaucoma (β×t = +0.0141 logMAR/month, p < 0.001) and vitreous opacities (β×t = +0.0096, p = 0.005) as the sequelae most strongly associated with visual decline. Methotrexate was independently associated with a more favorable visual acuity trajectory (β×t = −0.0071 logMAR/month, p < 0.001).Conclusions Pediatric noninfectious posterior and panuveitis is characterized by chronic, bilateral disease with near-universal sequelae. Glaucoma and vitreous opacities were the strongest drivers of visual decline, while methotrexate was associated with visual preservation, supporting its early use in this population.